Sixty-three percent of those polled believe they would be better off if the law were repealed. Just 11 percent say trashing the law — known derisively among Republicans as “Obamacare” — would make them worse off.

“It just sounds like more taxes,” said Kris Lineberry, a 29-year-old engineer from Des Moines who participated in the poll. “I don’t like it.”

The law, officially called the Affordable Care Act, is Democratic President Barack Obama’s signature domestic initiative. It aims to increase health insurance coverage and reduce costs through numerous policies that will go into effect by 2014.

GOP congressional leaders, presidential candidates and spinmeisters have excoriated the measure since its passage in 2010, variously calling it a “government takeover” of health care, a step toward socialism and a recipe for higher costs and worse care.

Interviews with several poll participants indicate those arguments have been heard and widely accepted by those most likely to participate in Iowa’s first-in-the-nation caucuses.

Gordon Anderson of Oskaloosa, for example, said he believes the law has failed to boost competition among private health insurers and limit medical-malpractice lawsuits, steps he said could drive down the cost of coverage.

“I think you have politicians making decisions on insurance items that are best done by medical people or/and actuarial people,” said Anderson, who retired from the insurance industry.

A spokesman for the U.S. Department of Health and Human Services, however, said competition will increase as additional provisions of the law kick in. The spokesman said boosting private health care competition is a major goal of the legislation, and will be achieved with the creation of “affordable insurance exchanges” in 2014 — marketplaces where consumers can compare plans and costs.
Perceptions are wrong, agency says

Poll participant Ken Richards of Des Moines said he believes the Affordable Care Act will effectively socialize medical care in the U.S., a development that would eliminate the profit motive, which drives health care innovations.

He thinks costs will rise and ultimately access to care will be restricted.

“Every time socialism has been attempted, it has continued to fail,” he said. “So why would we expect a different result with health care?”

(In response to this criticism, Health and Human Services again points to the insurance exchanges, which will rely on private health care plans.)

Richards said he supports a basic safety net for people otherwise unable to receive care, but believes the new federal law will offer extensive and expensive care, which would encourage people to seek out a doctor “for every sniffle.”

Pauline Ball, a retired real estate agent from Fort Dodge, expressed concern that the Affordable Care Act would cause her health insurance costs to rise as insurers are forced to provide more services to others for free.

Particularly upsetting, she said, are provisions she believes are in the law requiring her insurance premiums to subsidize other people’s abortions and contraceptives.

“I do not want to pay for someone else’s abortions, and I do not want to pay for someone else’s birth control bills,” Ball said. “That’s their choice, and I’m being forced to pay for it.”

Health and Human Services contends the care that is to be provided for free under the law is “preventative services” that will help people avoid illness and improve their health, saving money in the long-run.

HHS Spokesman Bennett Blodgett also said the Affordable Care Act “absolutely does not require insurance companies to cover abortions,” and that mandates for insurers to cover contraception include an opt-out provision for religious organizations.
Many provisions yet to kick in

The animosity toward the Affordable Care Act is philosophical and political — and also practical, public policy experts said.

Arthur Sanders, chairman of the Drake University political science department, said opposition from likely Republican caucusgoers stems from their contempt for anything associated with Obama, but also from the fact that many of the law’s provisions have not yet gone into effect.

Those who hold this view haven’t been challenged by much evidence to the contrary, he said, since the law’s major elements don’t go into effect until 2014.

“Most people who are going to see benefits haven’t seen any,” Sanders said.

University of Northern Iowa political scientist Justin Holmes said that Republicans’ ideological predisposition against government spending probably plays a role in opposition to the law, as does the fact that the typical GOP voter may benefit less from provisions extending health care access to those with lower incomes.

But Holmes, an expert in political communication, emphasized above all the sources from which Republicans have received their information about the Affordable Care Act.

“People tend to be persuaded by sources that they trust,” Holmes said. “When you have this really consistent, monolithic message coming out of the Republican Party that this is a bad bill that’s bad for America and that you shouldn’t like it, Republicans are going to go in for that.”
Even a supporter hazy about law

Follow-up interviews conducted last week by the Register suggest even some of those who support the health care law in the poll may have doubts.

Ben Johnson, a 25-year-old independent voter from Des Moines, said he would be worse off if the law were repealed since he’s currently taking advantage of the provision allowing young adults to stay on their parents’ health insurance plans until age 26. But, he said, he isn’t sure whether other aspects of the law will help or hurt him.

“I don’t have a very strong sense of exactly how it would affect me,” Johnson said, adding that he worries about the potential for the law to centralize control over health care within a single agency or organization. “I could see long-run effects negatively affecting me.”

Twenty-four percent say they believe their personal situation wouldn’t change whether or not the law was repealed. One was state employee Chad Rumbaugh of Elkhart, who said he didn’t expect the state’s health care offerings to change much because of the law.
Nationwide views differ from Iowans’

Perceptions of the Affordable Care Act among likely Republican Iowa caucusgoers differ markedly from those of Americans nationwide.

A Kaiser Family Foundation health tracking poll conducted in mid-October found that a plurality — 44 percent — of Americans believe the law wouldn’t make much of a difference for themselves and their families. Thirty-one percent — less than half the proportion reported among likely Iowa Republican caucusgoers — believe they would be made worse off by the law. Eighteen percent believe they would be better off.

Fifty-one percent of the nationwide sample polled by the foundation have an unfavorable view of the law, while 34 percent view it favorably.

The views expressed in the latest Iowa Poll continue the widespread antipathy felt among the state’s Republicans for Obama’s health care policies.

Iowa Republicans and Democrats were widely split in an Iowa Poll taken last February in their views of the job Obama has done in addressing health care. Overall, 34 percent of Iowans approved of Obama’s job on the issue, and 60 percent disapproved. But among Iowa Democrats, 66 percent approved, while among Iowa Republicans, 89 percent disapproved.

In an Iowa Poll taken in March-April 2009 — as the push for reform was under way in Congress — 79 percent of Iowans favored major or modest change to national health care policy. But the intensity of support for reform differed between the two major parties. Ninety percent of Iowa Democrats favored major or modest change, while 60 percent of Republicans did.